Form Sp-8130 - Settlement Request
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(Life Expectancy Retirement Option)
Client Name _____________________________________________________________ Policy Number _____________________________________
Address _________________________________________________________________________________________________________________
City ______________________________________________________ State _________________________________ Zip ______________________
I do hereby request the payment of my qualified annuity retirement benefits under the following Life Expectancy Retirement Option:
ˆ
Option 8 (Single Life Recalculated *)
*In the case of “recalculated” life expectancy, the life expectancy factor is
ˆ
Option 9 (Joint Lives Recalculated *)
recalculated on the payment date each year and is based on changing age(s).
ˆ
Both Recalculated (Spouse must be Joint Payee)
ˆ
Client Only Recalculated
ˆ
Option 10 (Single Life Unrecalculated **)
** In the case of “unrecalculated” life expectancy, the life expectancy
ˆ
Option 11 (Joint Lives Unrecalculated **)
factor is calculated only once, on the first payment (the Annuity Date)
and then reduced by one each year thereafter on the payment date.
I hereby request, in addition to my annual calculated distribution, an additional __________%, or an additional withdrawal to yield a total of
$ __________ as my distribution. (Contract limitation apply)
(I understand that my Annuity Date cannot be later than April 1 of the calendar year following the calendar year in which I attain age 70 ½.)
I would like my Annuity Date, when payments are to begin, to be the _________ day of __________________, 20 __________.
Joint Payee Name _________________________________________________________________________________________________
Joint Payee Date of Birth _____/______/______
Relationship of Joint Payee to Client __________________________________________________________________________________
__________________________________________
__________________________________________
_____________
Signature of Witness
Signature of Owner
Date
__________________________________________
__________________________________________
_____________
Signature of Witness
Signature of Joint Payee
Date
(Page two must be completed)
SP-8130.Rev.7.02
Page 1 of 2
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Parent category: Business